Individual
MR. SAMUEL JESUS ROSERO GARCIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 W. WHITE MOUNTAIN BLVD, SUITE D, LAKESIDE, AZ 85929
(928) 368-4547
(928) 368-4527
Mailing address
300 W. WHITE MOUNTAIN BLVD, SUITE D, LAKESIDE, AZ 85929
(928) 368-4547
(928) 368-4527
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
61056
AZ
208D00000X
General Practice Physician
Primary
019230
PR
208D00000X
General Practice Physician
61056
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019230
PR LICENSURE BOARD
PR
Enumeration date
12/31/2014
Last updated
06/03/2020
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